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Renal Artery Stenosis: To Intervene, or Not to Intervene, “That is the Question”

Authors

  • Syed S. Haqqie,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Anthony Nappi,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Gary Siskin,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Nouman A. Syed,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Ketan Ghate,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Roy O. Mathew,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Jeffrey Wang,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Mandeep S. Sidhu,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Vishesh Kumar,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Loay Salman,

    1. Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida
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  • Donna Merrill,

    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
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  • Muhammad UT Akmal,

    1. Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida
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  • Ali Nayer,

    1. Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida
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  • Arif Asif

    Corresponding author
    1. Division of Nephrology and Hypertension, Department of Radiology and Division of Cardiology, Albany Medical College and Albany Stratton VA Medical Center, Albany, New York
    • Address correspondence to: Arif Asif, MD, FASN, FNKF, Professor and Chief: Division of Nephrology and Hypertension, Albany Medical College, 25 Hacket Blvd, Albany, NY 12208, Tel.: 518-262-0769, or e-mail: asifa@mail.amc.edu.

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Abstract

Renal artery stenosis (RAS) due to atherosclerosis continues to be a major cause of secondary hypertension. It can also lead to renal dysfunction due to ischemic nephropathy. While major clinical trials have emphasized that medical management should be preferred over angioplasty and stenting for the treatment of renal artery stenosis, clinical scenarios continue to raise doubts about the optimal management strategy. Herein, we present two cases that were admitted with hypertensive emergency and renal function deterioration. Medical therapy failed to control the blood pressure and in one patient, renal failure progressed to a point where renal replacement therapy was required. Both patients underwent angioplasty (for >90% stenosis) and stent insertion with successful resolution of stenosis by interventional radiology. Postoperatively, blood pressure gradually decreased with improvement in serum creatinine. Dialysis therapy was discontinued. At 4- and 8-month follow-up, both patients continue to do well with blood pressure readings in the 132–145/70–90 mmHg range. This article highlights the importance of percutaneous interventions in the management of atherosclerotic RAS and calls for heightened awareness and careful identification of candidates who would benefit from angioplasty and stent insertion.

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